simethicone and Gastrointestinal-Hemorrhage

The optimal dose of simethicone before capsule endoscopy is unknown. Prior studies have reported inconsistent cleansing, with some showing improved visualization only in the proximal small intestine. We hypothesized a higher volume of simethicone may improve cleansing and diagnostic yield, especially in the distal small bowel.. A phase III randomized controlled trial was conducted comparing high volume (1125 mg simethicone in 750 ml water) versus standard volume (300 mg simethicone in 200 ml water) solutions, both at 1.5 mg/ml. The primary outcome was adequate bowel preparation, defined as a KOrea-CanaDA (KODA) score >2.25, overall and stratified by the proximal and distal half of the small bowel. Secondary outcomes included mean KODA score, diagnostic yield, completion rate, and adverse events. All analyses were intention-to-treat.. A total of 167 patients were randomized (mean (SD) age 58.7 (15.7), 54% female) and the most common indication was obscure gastrointestinal bleeding (71.7%). Adequate cleansing was achieved in 39 (50%) patients in the high volume group and in 39 (48%) patients in the standard volume group (RR 1.04, 95% CI 0.76-1.43, p = 0.82), with no differences observed in the proximal half (71% vs 64%, p = 0.40) or the distal half -of the small bowel (36% vs. 37%, p = 0.88). There was no differences in the mean (SD) KODA score (2.20 (0.41) vs. 2.18 (0.44), p = 0.73), diagnostic yields (53% vs. 56%, p = 0.71), or completion rates (both 95%). One adverse event, nausea, occurred in the control group.. High volume simethicone does not improve visualization during capsule endoscopy.. Clinical trial: NCT02334631.

Topics: Adult; Aged; Capsule Endoscopy; Cathartics; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Nausea; Simethicone; Treatment Outcome

Small bowel cleansing by capsule endoscopy has never been addressed in children.. Randomized controlled trial to evaluate the effect of five bowel preparation regimens on the mucosal visibility surface (as percentage of visualized surface area). Group A: a clear liquid diet for 12 h on the day before; Group B: high volume polyethylene glycol (50 mL/kg, up to 2Lt/die); Group C: low volume polyethylene glycol (25 mL/kg up to 1Lt/die); Group D: 20 mL (376 mg) of oral simethicone; Group E: 25 mL/kg (up to 1Lt/die) of polyethylene glycol solution plus 20 mL (376 mg) of oral simethicone.. Overall, 198 patients (53% male, median age 13 years) were enrolled. Preparation regimen visualization scores were 14.1 ± 4.2, 18.9 ± 5.1, 17.8 ± 5.5, 14.9 ± 4.8 and 20.9 ± 4.6 in groups A, B, C, D and E, respectively (P < 0.01). Positive findings were found in 172 cases (87%), but no significant differences were observed in the diagnostic yield and tolerability. Interobserver agreement, k = 0.89 (95% CI 0.83 ± 0.71).. This is the first report in children that supports the use of 25 mL/kg (up to 1Lt/die) of polyethylene glycol solution plus 20 mL (376 mg) of oral simethicone as the preparation of choice for capsule endoscopy.

Topics: Adolescent; Antifoaming Agents; Capsule Endoscopy; Cathartics; Child; Fasting; Female; Gastrointestinal Hemorrhage; Humans; Inflammatory Bowel Diseases; Intestine, Small; Male; Polyethylene Glycols; Simethicone; Single-Blind Method

We carried out a randomized, controlled trial of sucralfate vs antacid as prophylaxis against upper gastrointestinal tract bleeding in 50 patients who had undergone abdominal aortic surgery. The groups were similar in age, sex, duration of prophylaxis, and number of risk factors per patient. No patient in the antacid group had upper gastrointestinal tract bleeding. One patient in the sucralfate group had frank bleeding from the nasogastric tube; however, she also had a coagulopathy and thrombocytopenia. The bleeding stopped when these conditions were corrected. No complications occurred in the sucralfate group; five patients in the antacid group had minor complications. Sucralfate was as effective as antacid in this trial, and it resulted in a considerable saving in nursing time.

Topics: Aged; Aluminum; Aluminum Hydroxide; Antacids; Anti-Ulcer Agents; Aorta, Abdominal; Clinical Trials as Topic; Drug Combinations; Female; Gastrointestinal Hemorrhage; Humans; Intubation, Gastrointestinal; Magnesium Hydroxide; Male; Postoperative Complications; Prospective Studies; Random Allocation; Risk; Simethicone; Sucralfate

A prospective, randomized trial was designed to compare the relative efficacy of 15 (R)-15-methyl prostaglandin E2 with antacid (usually Mylanta II) in 46 patients admitted to a respiratory-surgical intensive care unit. Bleeding was assessed by a modification of the Hemoccult slide test. Three of 22 patients in the antacid group bled, and 12 of 24 patients in the prostaglandin group bled, for a highly significant difference (p = 0.008). Patients in whom prophylaxis failed tended to have a greater number of risk factors. Other prostaglandin analogues that do not require conversion from an inactive to an active form, may be more useful than the agent we studied. Based on currently available data, the hourly titration of the gastric juice to a pH of greater than 3.5 remains the preferred method of prophylaxis for acute bleeding from the stomach in seriously ill patients.

Topics: Aged; Aluminum Hydroxide; Antacids; Arbaprostil; Clinical Trials as Topic; Drug Combinations; Female; Gastric Acid; Gastric Acidity Determination; Gastrointestinal Hemorrhage; Humans; Magnesium Hydroxide; Male; Postoperative Complications; Prospective Studies; Prostaglandins E, Synthetic; Random Allocation; Risk; Simethicone

Over a 15-month period, 75 critically ill patients at risk of acute gastrointestinal bleeding were randomized into two groups: one group (38 patients) received the H2-blocker cimetidine intravenously at an initial dosage of 300 mg every six hours, and the other group (37 patients) received antacid (Mylanta II) through a nasogastric tube at an intial dosage of 30 ml every hour. Gastric pH was measured hourly and titrated above 3.5. Upper-gastrointestinal-tract bleeding occurred in seven of 38 cimetidine-treated patients but in none of 37 antacid-treated patients (P less than 0.01). When antacid titration was added to the cimetidine regimen in four of seven patients with bleeding, all four stopped bleeding. Renal failure, sepsis, peritonitis, hypotension, respiratory failure, jaundice, multiple trauma, and major operative procedures were associated with an increased incidence of bleeding. Cimetidine does not adequately protect seriously ill patients from acute upper-gastrointestinal-tract bleeding. Antacid is better for this purpose.

Topics: Acute Disease; Aluminum Hydroxide; Antacids; Cimetidine; Clinical Trials as Topic; Critical Care; Drug Combinations; Female; Gastrointestinal Hemorrhage; Guanidines; Humans; Intubation, Gastrointestinal; Magnesium Hydroxide; Male; Middle Aged; Postoperative Care; Postoperative Complications; Random Allocation; Risk; Simethicone

Prophylaxis of acute upper gastrointestinal bleeding by control of gastric pH has been widely advocated for intensive care patients. H2-blockers and antacids have been used and demonstrated to be incompletely effective at maintaining gastric pH above 4. A study of 100 patients measured the efficacy of two-hourly gastric pH measurement and titrated therapy consisting of five levels: 1. no therapy 2. ranitidine 50 mg 8 hourly intravenously 3. ranitidine plus Mylanta 30 ml 2 hourly by nasogastric tube 4. ranitidine plus Mylanta 60 ml 2 hourly and 5. ranitidine 100 mg 8 hourly intravenously plus Mylanta II 60 ml 2 hourly. The level of treatment required by proportions of the total study group were (1) 15%, (2) 71%, (3) 96%, (4) 100%. Head-injured and intubated patients generally fell in the more resistant group while patients having had major elective surgery required lower levels of therapy. If control of gastric pH is to be uniformly achieved, a technique of titrated therapy based on gastric pH measurements is supported as cheaper and more effective than other standardised treatment regimens.

Topics: Adult; Aged; Aluminum Hydroxide; Antacids; Critical Care; Drug Administration Schedule; Drug Combinations; Female; Gastric Juice; Gastrointestinal Hemorrhage; Humans; Hydrogen-Ion Concentration; Magnesium Hydroxide; Male; Middle Aged; Ranitidine; Simethicone

Gastroccult reagent was used every 4 h to detect blood in gastric juice in 41 ICU patients at risk of GI bleeding (GB) and receiving antacid prophylaxis (gastric pH greater than 3.5). Of the present patients, 27% (11/41) had at least one episode of occult GB (three consecutive positive determinations; a total of 14 episodes). Endoscopy identified acute gastroduodenal mucosal lesions (stress ulcers) as the most frequent lesion in this group (eight patients). Sepsis was the most frequent underlying condition associated with occult GB due to stress ulcer. Hematemesis occurred in 36% (4/11) of patients with occult GB and was due to stress ulcer in three patients and to benign gastric tumor in one. No overt GB occurred in the absence of previous occult GB. We conclude that: a) risk of GB persists in critically ill ICU patients in spite of antacid prophylaxis (gastric pH greater than 3.5); b) high-risk patients can be identified through periodic testing for the presence of blood in gastric juice using the reagent; c) when occult GB occurs, treatment should be based on the endoscopy results. In the absence of acute gastroduodenal mucosal lesions, antacid prophylaxis should not be modified, and specific treatment of the identified lesion(s) should be initiated. In the presence of stress lesions, antacid prophylaxis should be reinforced if the pH of the gastric content is less than 3.5 and a septic complication should be actively sought if the pH is greater than 3.5.

Topics: Adult; Aged; Aged, 80 and over; Aluminum; Aluminum Compounds; Aluminum Hydroxide; Antacids; Critical Care; Drug Combinations; Female; Gastric Acidity Determination; Gastrointestinal Hemorrhage; Humans; Magnesium Hydroxide; Male; Middle Aged; Occult Blood; Phosphates; Risk Factors; Simethicone

The abilities of antacid (Mylanta II), sucralfate, cimetidine, and ranitidine to protect the gastric mucosa against ethanol-induced necrosis were compared in a standardized, experimental rat model. Fasted rats received pretreatment with either saline, Mylanta II, 500 mg/kg of sucralfate, 50 mg/kg of cimetidine, or 50 mg/kg of ranitidine. This was followed one hour later by intragastric administration of 2 ml of 100 percent ethanol. Gastric mucosal injury was assessed four hours after administration of ethanol by quantitation of gross mucosal necrosis, assessment of mucosal histology, and determination of intragastric blood and protein concentrations. Pretreatment with Mylanta II or sucralfate significantly reduced ethanol-induced gastric mucosal necrosis. The protective effect of sucralfate was six to 10 times greater than that of Mylanta II. H2-receptor antagonists increased ethanol-induced gastric mucosal necrosis.

Topics: Aluminum; Aluminum Hydroxide; Animals; Antacids; Anti-Ulcer Agents; Cimetidine; Drug Combinations; Ethanol; Gastric Mucosa; Gastrointestinal Hemorrhage; Histamine H2 Antagonists; Magnesium Hydroxide; Male; Necrosis; Proteins; Ranitidine; Rats; Rats, Inbred Strains; Simethicone; Sucralfate